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Wow - feels weird... this is my first post... first time doing anything like this... I've been reading a TON on here since April and just finally got the courage to get an account.

I tested positive in April 2011 and have been seeing an ID doctor since. I've also been learning a ton over the past months, etc. - thanks a lot to this site! I've been struggling with which med to go on - Complera or Atripla. Have spent hours in my doctors office and just recently decided to go with Complera - mostly due to a long history of lipid issues with myself and also the CNS affects of Atripla versus slightly less with Complera (I guess). He said he cautiously nods his head to Complera for me.

What I am struggling with is STARTING the meds. My parents and close friends don't understand why I am struggling with starting. To a degree I can understand them. However, it's not them starting these meds that I will have to take for the rest of my life... and make sure I take them EVERY day... and with Complera, take with at least 400-500 calorie meal... etc. etc. etc.

I've looked a lot on here for others who have struggled with coming to grips with taking the meds and haven't really seen much - in case I have looked in the wrong place I know that I need to take start taking them. I know of the importance of them. I know my body will be better off with them and not feel so stinking fatigued all the time. But why am I struggling so much with what seems should be so simple?

Has anyone else experienced this? How did you overcome it? I appreciate the feedback and really want to thank everyone that posts on here because it has totally helped me over the months learning about side affects, etc. etc. This is a great site! Thanks for your input. It feels very strange for me to reach out to complete strangers asking for help. But I am struggling with starting these meds and am hoping maybe some others have gone through these feelings? Thanks again!

This is a common topic in the "I just tested poz" forums. I'm not good at copying and pasting links or I would direct you towards a couple. You can also go to the search function on the bottom left and search key words like; starting meds, new meds...etc...

My pat answer is; do you have this much concern for ALL of the other things you must do everyday for the rest of you life? I guess living with HIV for many years before drugs were even available, I'll never completely understand the hesitancy. I popped my first ones with pleasure.

You will find numerous people here who are currently or recently dealing/dealt with this issue.

You're numbers are great! You are in no immediate danger. You can certainly take a few more months to come to terms and become more comfortable with the idea of taking meds.

It may help if you were to find a therapist you can hash this out with in the meantime.

I've been poz for coming up on fifteen years and I'm still not on meds (infected in the spring of '97, but not diagnosed until 2001 - my eleven year diagnosis anniversary is coming up on the 22nd of this month). My numbers are very similar to yours and pretty much have been for the entire time I've been monitoring them.

The reason I'm not yet on meds is because according to the treatment guidelines we go by in the UK, my numbers do not yet indicate the need for meds. Otherwise, I'm fully ready to start. It did take me some time to get to this point, but I'm there now and have been for quite a few years. You'll get there too.

Please don't panic and think you HAVE to start RIGHT NOW. In my opinion, given your numbers, it's more important that you are mentally and emotionally ready to start. You have the luxury of having numbers that will allow you some time to get to that point.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Doing new "big" things that look like a long drop, maybe a parachute jump or the like, seems daunting. I think it is perfectly reasonable to feel daunted.

Maybe the block is because starting meds is an absolute confirmation that you have HIV, or treatment somehow equates to the beginning of the end, a brake before illness and death rather effective medicine that will keep you well, or meds with their day in day out obligation and regular eating is a prison, daily reminder, difficult and you may not do it proper for the meds to work, or side effects will make you feel ill/look AIDSy/become a zombie. Yes this or that and perhaps many other stories...

Your CD4 count is very good and you can take time to think this over, even as Ann suggests with a professional.

I am sure you eat at least one proper meal a day, and have done since you were very young, so what is the real food issue? Taking meds, in my experience and that of nearly all my friends, is pretty dull. Plus, they are a route to a fast, if not instant (but certainly fast), restoration of energy levels, so bye bye fatigue.

Meds are for the foreseeable future. HIV treatment is developing rapidly. Treatment you use now will be old hat in 5 years and radically different in 10. Expect it to be simpler and kinder by then (5 or 10 years time).

However, it's not them starting these meds that I will have to take for the rest of my life... and make sure I take them EVERY day... and with Complera, take with at least 400-500 calorie meal... etc. etc. etc.

Welcome to the forum.

I read your post and I dont see much, besides the above, specific about what contributes to your hesitancy about starting.

Maybe if you could think a bit more and list out some contributing factors, we could respond to each.

I see two factors in the quote above.

1) The drugs are for life.... Yes, I guess so for me, I'm middle aged. I am guessing you are young? I don't think everyone will be on HAART 50 years from now.... Also the "drugs are forl life" can be "read" two ways. It also means, as you know, that the drugs preserve life! In my case normal health. That's good.

2) Its a daily commitment. Well, for the moment, yes it is. I read again this week that there is still progress on the "patch" that would work for 1-week. And we can imagine that there will be other longer-term drug delivery solutions as time goes by.

Personally I didn't have this hesitancy about the every day aspect of HAART. It seems like such a minor annoyance that when people say that, some of us who didn't have the hesitancy wonder of its not a symbolic factor, standing in for other hesitancies, fears, issues, etc.

For example, I've heard some people in your shoes say it like - "it's a reminder every day I have HIV." Is that the issue?

Or, people who don't like or can't manage obligations, it can cause anxiety? Worried that you can't manage daily adherence, is that it?

You are sitting pretty. You have regular blood work, access to meds, a supportive family. And your immune system isn't collapsing. So you can address what the real issues are.

On the other hand, if by any chance some one is a naturally anxious type, or over-thinker, or worrier, or ruminator, than "time to think" isn't always an advantage.

I bet I would have become a ruminator about HAART and my body and my HIV infection, worried all the time about how I was doing without medicine, or how the medicine might change my life, etc, etc, but I only had a few months from seroconversion to HAART. I wasn't doing well, at all, didn't feel well, and was skinny and weak quite fast. So when the doc said it was my time, I took it and didn't look back.

Just goes to show there are always two sides (seeming contradictions) to most realities.

Like the "HAART is for life thing." Yeah, what a drag, but also how amazing is that!

« Last Edit: February 11, 2012, 09:02:26 AM by mecch »

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“From each, according to his ability; to each, according to his need” 1875 K Marx

I don't sense by what you've written that you're in a panic--and everything you've written reads as normal pondering process to me. Your doctor may be guiding you according to the advice that people start meds once their CD4 count goes below 500--which means he or she is taking a considered approach advised by the NIH.

One angle you might want to take is thinking of those who never had a shot at taking meds --either due to them not being yet available or access. But, you've written one of the best reasons to envision taking them more easily--that you'll simply start feeling better!

I don't mean to shake up your thinking yet again, but has your doctor put Isentress in the mix of drugs you could take? While it's a two-time a day regimen, most everyone here who's on it has had a good experience with it. There's no rule regarding taking with a certain calorie meal, no CNS issues, etc. If it's an option for you, I suggest you search Isentress here and just see the various aspects of it that have been discussed.

I went for 7 years past diagnosis before starting meds with full, regular care from good ID docs. Knowing what I know now, I would have started earlier. Despite my numbers being "good" with a CD4 count near yours and VL never above a couple thousand, what changed my mind is what my one doc said -- that she felt my system was likely fighting like hell to keep the numbers as they were.

You mentioned not finding much evidence of people struggling with the decision making process. I think there is evidence throughout threads of denial, the want to delay as long as possible, the concern about possible side effects, etc. Just like the virus, the decision process is different for everyone, including being on death's doorstep, not having any time to think in order to live.

You're getting lots of advice including your doc's-- you'll figure out the path that feels best for you.

This is my 27th year HIV positive starting from a less than 80 CD4 count and I have taken meds nearly the entire time (starting with AZT in the 1980s) with very good adherence and a fairly decent quality of life along the way. I am sure that greatly contributed to me being able to live to type the tale today.

All I can offer aside from what others have said is that taking meds as prescribed by your doctor will help you "live". With the changing medical landscape, things continue to improve and may become even better down the road as Matt notes. Don't you want to be there when they do?

I am sending you best wishes as you work through what are normal feelings of hesitation.

Take care.

« Last Edit: February 11, 2012, 10:56:03 AM by OneTampa »

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"He is my oldest child. The shy and retiring one over there with the Haitian headdress serving pescaíto frito."

Hey Forrest welcome to the forums. I can understand you hesitation however I really don't think you should stress yourself out from taking a 1 a day pill. You won't even notice any changes in your mental or physical health other then maybe restoring your energy level, preventing the virus from further damaging your immune system, and also if you do engage in sexual activity will limit transmission of the virus significantly. So all those reasons sound like a no brainer to me. There are alot of new meds out there one of them being complera, which all of them include no to little side affects again depending on the person. So if complera just doesn't agree with you, which I think you willl be entirely fine on it i know someone personally who just started it and is living a normal life side affect free, you can simply talk to your doc and find something that will. Don't let it stress you out, you have so many other things to worry about it, taking a pill as you would a vitamin C once a day shouldn't be something to dwell on. Best of luck I know you will be fine!

As to the meds, one way I found that makes it seem a lot easier for people is to ease into it.

Do you take a multivitamin every day? If not, try taking one. You will most likely find that, after a brief period, it will simply be second nature for you.

Taking your regimen is really not much different. In time, and probably a relatively short time, you will find it is second nature, like taking the vitamin.

As for the meal, just plan to take your pill with breakfast. That is the most important meal of the day and should simplify the process for you.

Like Wolfie, I was diagnosed years before meds were available. But, I remember the doctor talking to me about starting and my taking a few months to mull it over. (It didn't take much convicing, but it had been 11 years since diagnosis and it was yet another step in my HIV journey.)

However, it's not them starting these meds that I will have to take for the rest of my life...

Hi,

First welcome to the forum...

On one hand you're correct and on the other not.

At one point of life, almost everyone (think of the elderly) has to take meds, has to go to hospital for exams, etc. so they will have to do it as well.

Getting adjusted to one's meds and conditions is not so easy, but, hey, you'll get there, like the rest of us.

Will there be a time when we will have to take no meds, or less intrusive meds, or less meds. I am 100% convinced this will happen... and not in 50 or 60 years!

I am 18 months into treatment, and doc and I are starting open discussion about next step, what we would like to start looking at for say year +3-5; meeting with doc is 3 times/year so we are only 10 meeting away from a (potential) change. You'll have much more 'meetings if you are looking for a job or mortgage ;-)

Ever since you where born, you've had to have 3 meals a day; missed few... then what ?

Once you are UD for a little while missing one dose by chance is nothing.

I hear you Forrest. I was very proud to say that although hiv+ I didn't need meds because my body is strong enough to keep the hiv at bay. But my 'badge of honor' has been taken from me since I now have to go on meds. When I was first diagnosed my dr said that many go for years without needing meds, so I felt that I was going to be one of them. 6 short years later I need meds. Our bodies haven't failed us or our sheer will, instead we're given a new way to find the bright side of our situation. Which is, we're still strong and determined to live the best life we can, every day. Just like when I found out I was +, it took me some time to grieve. I think it's ok to do that for the loss of being med free. One day at a time! Best to you.

First of all, thank you everyone for your thoughtful replies! I really appreciate it! It's weird now getting answers from some of you because for many months, I have just observed and now you are replying to ME

I'll try to answer everyone.

@ Wolfter - actually, I DO analyze everything very carefully in my life. It's a curse and a gift. I think things through carefully (typically) and especially on big decisions. It's part of my 'wiring' and who I am. I drive myself crazy sometimes but it's me.

@Ann - wow, 11 years and your numbers look like mine huh? You are right about counseling. It's one of those things that I need to do and haven't done. It seems like ever since becoming positive, that I don't have the same energy so everything is prioritized on the amount of energy I can spend (or feel like) on something. Going to counseling (I've done that in the past) takes time to build up a rapport (I have moved since my last counseling so I am starting over with a new person). I'll get there (soon) and totally agree.

I am definitely not panicking Although, both ID doctors have said if they were to have HIV, they would have been on the meds already. They feel this way because of the amount of effort my body has to perform in order to keep those VL's low... so they said it was like my body was fighting this battle 24 hours a day and no time for breaks. Plus, with the HIV comes the inflammation and that concerns them on the heart especially. I just need to start and thus why I finally posted to help tip me over the edge

@Newt - Matt - you are another one that I've seen post a lot and just weird now having you reply to ME. haha. Like you said, "Doing new "big" things that look like a long drop, maybe a parachute jump or the like, seems daunting. I think it is perfectly reasonable to feel daunted. " Yes, this is pretty accurate. It is a 'big' thing to me and it is daunting. Not daunting in the sense that I worry about taking the meds... I already take supplements and have taken some other meds for many years. The routine isn't the issue and like my doctors say, they don't worry about adherence with me. However, with my current meds, I take them either in the morning or at night when I go to bed. The night ones aren't as spot on the same time every time. It's just the meal aspect of Complera b/c some nights I am just not hungry. I don't eat enough in the morning and so that would leave lunch. I think I may start taking at night with dinner but then switch to lunch as I think I am most consistent with lunch.

Ah, and you were the one that said "Plus, they are a route to a fast, if not instant (but certainly fast), restoration of energy levels, so bye bye fatigue." A friend and me were talking about that comment last night.

I have two really good friends that have been trying their best to help support me but they are overseas and it can be difficult for them to address the hiv related issues directly. I have very little support (thus, another reason for counselor).

I kind of addressed some things here that I know others brought up...@Mecch - Another person I've seen post a lot Specifics. I even struggle with this Mecch. Sometimes I don't even understand myself. I get it... I should be thankful that there is even medicine out there! I should be thankful that I can only take one pill once per day! And I AM thankful for those things. That's where I struggle with myself because it's like.. wtf... why are you so hesitant on this?!?! (saying that to myself). It's a battle. If I had cancer, I would be on the meds immediately. So, why am I being so difficult with myself on HIV meds? I think because my numbers are still decent, but I also worry about the toll it's taking on my body not being under control.

You stated "On the other hand, if by any chance some one is a naturally anxious type, or over-thinker, or worrier, or ruminate, than "time to think" isn't always an advantage." - I am a naturally more anxious type I don't get anxious about everything and have worked on that for several years, but I AM a thinker - fo sho! That is why my friends are trying to get me to think about other things and just getting on the meds will take a weight off my shoulders. I have other fish to fry right now (have lots of life things going on). It was a big decision on just what drug to take. My doctor (I am so thankful I have such a cool doc) has spent hours with me. And knowing me, my issues, my history, family health issues, etc. finally agreed that Complera would be the best to start out with.

You could be right. Maybe it's the taking it every day thing that I am reminded of hiv... but, I also take a pill every day for cholesterol and also another for triglycerides... those remind me every day that I have those issues. So, why should this one be any different? That's where I start to get into a battle with myself.

Like I stated before, compliance will not be an issue with me. I also don't think I am in denial. I know I have HIV. It's on my mind a lot and I can't wait until I get to that point where it's just more of an annoyance or way of living. I am not there yet

And the 'patch' - really?!?!?! That is awesome! My friend was talking to me last night and he was like... dude, you may be starting off with a pill now every day, but like some people in the forum posted - that will most likely change in time. I mean, one guy even said they are working on a patch. That is really cool! I haven't heard or seen anything about this.

@Emeraldize - haha. Thanks for the link. Believe it or not, I have read through that already. Like my doc said, I have probably studied on this more than most at my juncture of having this But, it's stuff like that that I find helpful so thank you. And you are right, not panicking

We (doc and I) talked about different combinations but when I had more than one pill, that was more than one prescription and my co-pays are fairly high so it got more expensive and that would add additional 'weight' to all of this so that was another reason he supported a one pill regimen for me right now.

You said "that she felt my system was likely fighting like hell to keep the numbers as they were." - you are so right with this. This is basically what my doctors have said. I have felt very fatigued and my brain feels very foggy a lot of the times (and have had memory issues - most likely due to add and the ruminating over hiv thus not processing a lot of stuff). But, yeah - the battle thing with your body and how it's best to give your body a break. THAT is why I am wanting to go on meds now versus continuing to wait. It's just getting myself to finally ask to call in that prescription and start the process.

@OneTampa - wow. 27 years huh? Amazing. You have certainly seen huge changes and are probably someone who is looking at me like... wtf... I had to take 30 pills a day and you are whining about taking one pill a day? Good grief. And that is part of the battle because I can see where you have been to hell and back probably and would be thankful to only have to take one pill. I do get that. But you said "With the changing medical landscape, things continue to improve and may become even better down the road as Matt notes. Don't you want to be there when they do?" - that is a very good point! To be there when they do. That, again, is why I WILL take meds (sooner than later). I just have to get over this mental block thingy that I am going through

@csguy1 - I am trying to not stress because I know stress is such a bad thing in itself for the immune system. That is good to hear that you know someone who just started Complera and is side affect free. I have read that quite a bit. I have read that with Atripla too... just depends on a persons body, etc. Thanks for your comments!

@Aztecan - wow, another person that was diagnosed prior to meds even being available. My comments to OneTampa would apply to you as well I'm working my way from the top to bottom so by this time, I have addressed some things you commented on such as taking a vitamin, etc. Thanks for your comments and support!@Eric48 - 20 minutes on your post... thanks a lot for taking that time out of your day to reply!! I appreciate it. I think I am at 30 minutes myself right now I was busy yesterday and wasn't able to reply but wanted to reply to everyone because I appreciate the time that people take to reply.

Like some others, I think by this time in my post, I have addressed some things you hit upon. I actually AM a very organized person. I already have what I call "granny pill boxes" that I put my meds in and take daily. I strongly encourage them because I hardly miss a beat by having those on my counter and taking them daily.

But wow, you didn't struggle at all with taking the meds huh? I wish I were more like that. It's not actually the physically taking of the pill... because again, I already take supplements and meds... it's the timing of it... and that I will get over... it's merely taking it... and how I can't miss a day... it's not like my simvistatin where if I miss a day for whatever reason, I'll be okay. I guess it's the seriousness of the pill and how I need to be perfect with it (or damn near perfect) because I sure as hell don't want to become resistant. It's more of that, not the act of taking it. It is nice to see that others have gone through these same feelings though.

That is helping just reading replies, etc.

@kjo - Wow, so you went 6 years and then things just went downhill fast. I do have that sort of worry and don't want to harm my immune system any more. I was a little worried last time because I had been consistent and my numbers were pretty stable... but then my CD4 number dropped quite a bit the last time. But, that is just the number though (not the %) and I had just come back from a 2 week vacation and also 41 hours of travel from the other side of the world. So, that alone could have been why my numbers went lower. Who really knows. And I like what you say... going through grieving for being hiv med free. I am losing that. But like someone else said, I should also be thankful for at least having meds! Thanks for your comments.

Wow - I bet this is going to be a long post. But I wanted to address everyone because I appreciate you taking time to reply. Thank you! It's great to have support from others going through it. And, I admit, I may go back and forth and at times be confusing. It get mad at MYSELF for that at times... Thanks again!

Are you available to write thank you notes for holiday and birthday gifts? You are a complete communicator, for sure!

One item " We (doc and I) talked about different combinations but when I had more than one pill, that was more than one prescription and my co-pays are fairly high so it got more expensive and that would add additional 'weight' to all of this so that was another reason he supported a one pill regimen for me right now."

I don't want to intrude, but wish to ask if you are in the US. If you are, at present, I believe all of the pharmaceuctical companies offer the insured co-pay assistance. I just learned about this within the last couple of months. ALL of my co-pays are now covered to the tune of more than $800 in a year's time. AND, lots of people don't know about this including doctors and pharmacists. I'll hunt around for the link for you to read and share with your docs. Perhaps it will give you a chance to reconsider your options before finally deciding to start.

Em

Here you go...http://positivelyaware.com/2011/11_02/copay_chart.shtmlI recall one of the phone numbers was off for one of the companies, but you'll figure that out and you'll note if Complera is your final choice, it's on the list as well. I need to give credit to Billy B, a poster here, who made mention of this in a thread once--I followed up for myself and have since told MANY people -- long-timers who hadn't a clue such relief was available. One guy told me he's going to save roughly $1200 a year.

I would say, just overall feeling reading your posts, you are over thinking this, going in circles, without actually making very specific lists and ticking off each item.

List all the reservations and hesitations and tick them off - resolved - or "resolved that I can't resolve this". And move on. List all the advantages of starting, and check off each one.

You seem to be able to put some reasons for the hesitation into words, but not enough to satisfy yourself. But you don't need to have it "all worked out", my dear. Your standards may be too high.

Do you trust your doctor and his professional wisdom?

I'm wondering how on earth any ID doc has "hours" to discuss your possible HAART regimens. From a Swiss perspective, this is very unusual. I guess you got lucky, or, perhaps, are you exaggerating a bit?

Routine ID appts are about 20 minutes for me. My first doc, they were 15 minutes. When I serocoverted I didn't get hour long appts, either. Maybe once! Or longer if there were examinations to do.

Just saying....

You seem to have a good head on your shoulders but you are an over thinker and sometimes its better to let others do some of the thinking and deciding, since you have certainly done your homework, you don't have to do it over and over and over again, "never handing it in" as it were.

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“From each, according to his ability; to each, according to his need” 1875 K Marx

Em - not overstepping bounds... I am in the US. Thanks for that list! I should look at that site more actually. I have used this site a lot and TheBody over the past many months.

Mecch - no doubt about it. I am a thinker and probably am over thinking this. I agree with you and I can drive myself nuts at times. It's just a bit decision. And in regards to the doctor... Actually, I am not exaggerating I think you guys will find with me that I am very straight forward and to not stretch the truth. My doctor (the last time) came in the room at 1:30p for a 1:15p appt. I was walking out of the clinic at 3:00p because I remember looking at my phone. He knows I am analytical and was really struggling. He is actually the director of this clinic on top of it. He really cares about his patients though and even recommended making the appointment with him to just sit down and talk.

I am very fortunate in the regard that I live in a town where they can afford to spend time because it's not a huge city and not a ton of hiv patients (compared to larger cities). I am VERY fortunate to have such an awesome doctor and that he really has spent hours with me. He gets concerned about the stress that just making the decision makes on my body.

Through talking with my friend over the weekend and also just all of your responses on here... I am thinking of maybe setting a date. My one year anniversary of the confirmatory test is April 6th. April 6th is a Friday this year and they've recommended to me to start on a Friday night so I have the weekend to face anything before going back to work. So, I am kinda thinking now that I will make April 6th my day to start?

It really does help to hear from you guys. I also have a mentor that I talk with and that helps as well. Thanks again everyone.

When I was newly diagnosed, the thinking had just swung from "hit hard, hit early" to "wait and see". The thinking has now swung back to early treatment, partly because we know more now about what ongoing, untreated infection (with low VL, good CD4s) can do long-term and partly because the meds have improved so much in the past ten years.

I'm on the fence. I can't help but wonder how many long-term non-progressors and elite controllers are being missed through early treatment, and the implications of not having more elite controllers to study and maybe find a cure or vaccine when we finally figure out why there are elite controllers in the first place.

(Just so you know, there are people who can control the virus on their own - they get labelled LTNP and ones who manage to become and remain undetectable without meds get labelled elite controllers.)

And then there's people like me who fall in the middle - long-term SLOW-progressors. If I had it to do all over again during the same years, I wouldn't change anything - but if I were doing it all over again today, with the improved meds, greater knowledge etc, I think I might have gone on meds sooner. In fact, I'm hoping to go on meds - regardless of my numbers - sometime this year. (yeah, "shock-horror" from folks who have known me a long time)

So you over-think things. That's not necessarily a bad thing, particularly when it comes to such a serious matter like how to handle an hiv diagnosis treatment-wise. As I said in my first reply to you, you do have the luxury of taking your time to figure this out. But you've got a plan in place now and all you have to do is stick with it. You've done the thinking, now just get on with it. I wish you luck.

And thank you for coming back with such thoughtful posts. I was starting to think that you weren't going to return! It was worth the wait.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Thanks for clarifying "long term non progressor" and "elite controller" Ann. Now, I just have to remember I don't know what the deal is... but man, my memory just is horrible over the past year.

So... I gotta ask... what is keeping you from going on meds? It seems that your body has been fighting hard for many years now to control the virus and I am sure it would be thankful for some help? Are you afraid to go on meds? Enjoy the freedom of not being on them? I know you said you were planning on going on them this year. I only ask (not to nag or anything) to see if you are in a same place as I am is all. I am curious as to what is going on in your head about it and see if I can draw from that.

My mentor said when he got his meds, he stared at them for 2 days. He said it was the most difficult thing to do. I do have a fear of the side affects or the unknown. I could be fortunate and not have any side affects - you just never know. It is a bit scary though. The meds are very potent and you just never know how your body will react to them. I hope that Complera ends up working out for me. Anyway, just curious as to your own thoughts about going on meds.

I AM thankful for the folks on here. Maybe some day, I will be able to be helpful. I figure that folks spend time to put thoughtful responses into writing, the least I can do is reply back with some thoughtfulness. I am sure I will post on here more in other forums as I really do still have quite a few questions. I actually tried to sign up back in October but it didn't accept for whatever reason and so I finally got the courage to try again now and it accepted (same username, etc. etc.). Maybe the system was glitchy back then. But I do have other questions that I hope to ask at some point.

In a nutshell, the NHS, the British treatment guidelines from BHIVA, and the Liverpool Heath Care Trust are what's stopping me. The Trust doesn't want doctors to treat hiv positive patients who have numbers like mine. It's the crappy economy, donchaknow. False economy in my opinion, but it is what it is. My doctor's hands are tied and he'll have to answer to the Trust if I go on meds now. He'll be able to get my treatment approved, but it's a hassle for him and the clinic in general.

I'm not afraid in the least. I've been (psychologically) ready to start meds for a few years now. In fact, when I was first diagnosed, I practically begged my doc to put me on meds - I wanted to feel like I was doing something about my infection. He explained to me that (at the time) they didn't treat until a person's CD4s were in the 200s. He told me there were better meds coming along and I could - and should - wait.

I'm glad I did wait. I would have been put on Sustiva and Combivir and knowing what I know now about Sustiva, I will not take it. Same goes for the AZT in Combivir. Had I started back then, there's no doubt in my mind I would have been really whacked out on the Sustiva, due to my track record with other meds.

(If a med has neurological/psychological side-effects, I usually get them. Champix (an anti-smoking med), for example, can make some people suicidal and it did me. I'm never normally suicidal and no, I didn't know about this possible Champix side-effect until after it started happening. It was pretty frightening.)

I've been asking to go on meds for the past few years now, but they keep saying "lets see what your next results are like". I'm going to see my doc next Tuesday (was supposed to go last Tuesday, but there was fog in Liverpool so my flight was delayed to the point where I missed the appointment and had to reschedule) and I'm going to do my damnedest to finally get a script. I'll probably go for Norvir boosted Reyataz, plus Truvada. A once a day dosing schedule is best for me as I am CRAP at remembering a dose later in the day. Mornings are good though.

I was perfectly happy about not being treated for years. I wasn't afraid of starting, I just didn't feel the need because my numbers were good and I felt fine. However, in the past few years I'm noticing things like having a difficult time getting over ordinary infections and an increasing lack of energy. Plus, I'm not getting any younger and neither is my body. So yes, I do feel it's time to help my body fight these little buggers.

I'll post my numbers history at the end of this post. By the way, I was actually infected in the spring of 1997 (hindsight is a wonderful thing) but I wasn't diagnosed until February 22, 2001. So I had been poz for four years when my first labs were taken. I have no idea what my numbers were like during those four years.

Just so you know, the current BHIVA (British hiv association) guidelines are to start between 350 and 500, preferably closer to 350 and for more than one or two lab results. Very similar to the US guidelines, but not exactly the same.

I AM thankful for the folks on here. Maybe some day, I will be able to be helpful. I figure that folks spend time to put thoughtful responses into writing, the least I can do is reply back with some thoughtfulness.

I'm sure you will be helpful - and to be honest, you're being helpful now just by discussing your situation. The question of when to start meds is a very common one that many people grapple with and the more we talk about it, the more others will have these discussions to read and it helps. It really does.

I am sure I will post on here more in other forums as I really do still have quite a few questions. I actually tried to sign up back in October but it didn't accept for whatever reason and so I finally got the courage to try again now and it accepted (same username, etc. etc.). Maybe the system was glitchy back then. But I do have other questions that I hope to ask at some point.

The only stupid question is one that you don't ask. We learn by asking questions and knowledge is power, so ask as many questions as you need to. That's the primary function of these forums - to empower people with knowledge. Support is an extremely close second.

We recently upgraded the forum software. Before the upgrade, we were inundated with as many as 150 - 200 spam bots in any given day. It was very easy to accidentally delete a legitimate account when dealing with so much bot traffic and that's probably what happened to you. (Sorry! There's a very good chance that I was the guilty party. ) The new upgrade is better at stopping spam bots during the registration process, so far fewer are turning up in the approvals list now. We're only getting five or six (if that) bots a week, as opposed to hundreds.

Where the VL is listed as 00,000 it wasn't undetectable, it's just that the test wasn't run. I used the zeros to keep the formatting neat and pretty.

You'll notice that the last time I saw my doc and had labs done was last July. (and I can't remember where I wrote the results down, but I remember my CD4s were 400 something. I think.) I was supposed to go in October, but I missed the appointment.

Coincidentally, my BF also missed his appointment earlier that month. He told me that he received a new appointment through the post within a week, so I waited for mine. And waited. And waited. To be honest, I was pretty pissed off about it and coupled with the way they won't put me on meds, well, I just said "fuck it" for a while. Not something I'd ever recommend to anyone else, but hey, do as I say, not as I do. Right?

My boyfriend started nagging me (something he never normally does) about ringing up to book a new appointment, so I finally took notice (Foxtrot Charlie nagging? Must be serious! lol) and rang earlier this month. I've ended up with the same day as his. It's always nice to be able to go over with him, we usually have a nice afternoon together, lunch, shopping etc. He's been stable on meds for over ten years, so he only goes every four months (I go every three - or should) and it's not that often that our appointments coincide. The last time was the day Obama got elected.

A year ago January, I thought I had it nailed when my labs came back - particularly that low percent. Again I got that "let's wait and see what your next labs look like" and of course the damn CD4s popped back up over 500 again, with a decent percentage. I was told "no way" could I go on meds with numbers over 500 and with a healthy percentage.

To be honest, I think I'll probably be refused again, because of the length of time since my last labs. I'll get the "let's see what these results are like first" crap. (Because I fly to Liverpool to see my doc, I don't know my current labs when I see the doc. I either have to wait three months to find out, or I can ring up a couple weeks later. This can be a hassle depending on who you get on the phone, but there's a new nurse specialist who seems to always be answering these days and she's really nice and helpful.)

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

I do have a fear of the side affects or the unknown. I could be fortunate and not have any side affects - you just never know. It is a bit scary though. The meds are very potent and you just never know how your body will react to them. I hope that Complera ends up working out for me.

Usually you can find a combination that results in no side effects that you feel in your daily life. (Of course, who is to say what will present 10 or 20 years down the road with things like cholesterol or bone density or liver damage, etc etc. But none of these problems are sure things.)

I do hope that your doctor explained that all combinations work on HIV, there is no chance of failure in that respect. Anyone who gets medical surveillance and takes the drugs as prescribed gets HIV under control.

The way I see it, it is medical science - vast networks of researchers and doctors collecting information about big populations, that is being filtered through my doctor and his professional opinion. So when he (she) says its time for drugs its because the drugs are a lessor risk than an active HIV infection.

(As Ann explains, that suggestion by a doctor above is made in a vacuum of course, not taking into account other factors that depending on a person and location, come into play.)

Sometimes we come to a fork in a road and both paths we could choose have disadvantages. Its not like one is clearly candy lane of paradise.

Anyway, we both know eventually all paths lead to HAART, and HAART (taken correctly) leads to life, so personally I'm not sure the couple of years one "might have gone longer without haart" makes all that much difference in the long run of life.

I'm glad I could let doctors figure such calculations for me, its their area of expertise not mine. It must be a tricky calculation all the things a doctor like Ann's doctor must take into consideration, including payment!

And you have already got the medical recommendation to start. So it is just you who needs to find the determination.

« Last Edit: February 14, 2012, 08:29:39 AM by mecch »

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“From each, according to his ability; to each, according to his need” 1875 K Marx

What sucks is that you can't just do what you want to because of how your medical system in the UK is set up But, not sure that it's still not better than here. I wish we would have health care reform here but that is a whoooooole other topic

Do you have the option of telling them that your body has been fighting this for many years now and that you would like to go on meds? period? Or isn't it that simple? You'll have to bear with me as I am not familiar with socialized healthcare. Don't YOU have any say in YOUR health?

Your long history of VL & CD4 and CD4% is interesting. It also brings up something else... a question I was going to ask in another forum... but since your numbers show this... I noticed that your VL has gone down different times... yet, your CD4 has also gone down. Just like mine - my VL has gone down quite a bit since initially finding out... but then, so has my CD4. I would expect my VL to go up while my CD4 go down. My doctor explained this to me... but I, unfortunately, didn't grasp it. Maybe you understand that better than I since you've been watching yours a lot longer not on meds.

I do know you are supposed to look more at the % versus the number as the number can fluctuate quite a bit. Yours is interesting though because it goes up and down through the years.

Thanks for commenting that I am even being helpful now by talking about this. I feel like I am so draining right now on what little friends that do know about me... and on my mentor... so it's nice to know that maybe someone else who is struggling with this may find benefit by reading this. The threads that I have learned a lot from on here are the ones where people diary daily when they start meds. Mostly, they are 'Atripla diaries' but none-the-less, it gives an idea of what it's like going on meds.

You are so right about knowledge being power! My old manager used to tell me that all the time. She'd tell me not to worry if I didn't know everything, but if I knew the resources to reach out to... that's what was important. That statement is kinda contradictory I realize... but anyway... I'm kinda tired

I know what you mean by wanting to just say fuck it. I have felt that way many times. I have felt this all very overwhelming many times. It does get daunting thinking through everything. I feel that you really have to look out for yourself. I can't just put all my health in someone else's hands and not have a play in it. Yes, I trust my doctor, but I also have to look out for myself because no one knows myself as well as I do. And, they (doctors) are humans as well and have off days... with something as serious as this, I feel like I have a responsibility in all of this as well - thus, why I do my own research, etc.

Do they have any idea why your numbers do go all over the board? I am fascinated by them because they go up and down, up and down... OR, is that just what it's like for a long term slow progresser? It goes up and down... but if you look at it from a 10,000 ft level, the bar is actually going down slowly with peaks and valley's along the way.

Reread your post again... I AM nervous about the CNS aspect of going on these and will definitely be asking my friends and parents to be checking in on me daily for awhile when I go on because I worry about depression. I've already been quite depressed and down about things and I hope that meds don't make it worse. I think that is one of the main reasons why he is putting me on Complera versus Atripla. I did ask him about anger issues as I have read quite a few people comment about being angry on Complera. He said that he hasn't experienced that with any of his patients. But, thinking of what mecch asked one time (or someone)... one of the reasons why I am nervous about going on the meds is the cns reasons.

Anyway... thanks for your info. Interesting. I don't remember seeing you post your history before in any of the other threads that I have read. Take care!

I should have replied sooner but I missed this thread as I don’t come to these sections too much since I, like Ann, am treatment naïve. I’ve been poz 6-7 years, although diagnosed only a year ago.

I haven’t read everybody’s replies so I apologize in advance, if what I say is duplicative (or redundant).

I can totally understand and relate to your ambivalence, concerns, fears regarding starting meds. So you’re definitely not alone! My two main (highly emotional) concerns were (kinda still are): 1. Once I start there is no going back and 2. Why put pills in my body when it seems to be doing its job ok for the time being?

It’s noteworthy that the START clinical study results that are to conclusively determine whether (and how much) there is a net-benefit in commencing ARV therapy with counts above 500, are not yet out. I say this not to dissuade you from beginning treatment but just so you know that there is really no urgency to start treatment as long as your CD4 counts are stable and consistently above 500 (or even the 350-400 region). It is, however, a fair bet that chronic immune activation, inflammation and other issues may be harmful somewhere down the road even with high CD4 counts, though the long term effects of HIV infection with high CD4 counts aren’t proven beyond a shadow of a doubt and many variables come into play. But arguably, the same applies for long term consumption of ARVs (this can vary from person to person and is affected by multifarious factors).

Also, the treatment guidelines nowhere in the world deem counts above 500 as a ‘must treat asap’ scenario. In fact, in EU and Asia, doctors are generally reluctant to put someone on ARVs before CD4s drop to 350.

In the end starting treatment with high counts such as yours is a decision between you and your doctor and one that you should feel comfortable with.

For a start, I wouldn't trade the NHS for the American system for anything. No way, no how. Not sure if you're aware, but I'm an American ex-pat. I moved here when I was almost 29, so I do have experience in the American health system, including having an emergency op without insurance (took me years to pay that off).

I thank my lucky stars that if I had to end up with something like hiv, that I did so while living in a country that has socialised health care. For all the faults of the NHS, it is still far superior to the broken American system. And I say that from personal experience. Not to mention all the worry I see in these forums from people living in the States.

The clinic I go to is in a teaching hospital. This means that while I have a consultant (a consultant is high up in the doctor food chain) who ultimately oversees my case, I'm often seen by a registrar (like a resident or intern in the States). I don't mind - they have to learn somewhere. But it's useless seeing one of these if you want something outside the guidelines.

I've been avoiding them ever since I wanted to talk treatment with one of them and she didn't know that Isentress (raltegravir) had been approved for use in the UK - and argued with me about it instead of looking it up. She dismissed the subject with "you don't need treatment anyway".

I can insist on seeing my consultant (Professor Khoo, he's great - I call him the Wizard of Poz) and I sometimes do, depending on what's been going on with me. There are two other experienced doctors I'm happy to see when Khoo is away at a conference being brilliant or just having time off. There's one woman doctor I avoid at all costs. But I do have that choice.

You have to understand that if my CD4s indicated the need for treatment, I would definitely be on treatment. They're not going to sit around twiddling their thumbs while I keep getting results in the low 300s or 200s. But that's not where my numbers are at.

You also have to understand that there is no proven benefit (yet) to starting above 500. That's why the guidelines are what they are. And if you look over the past few years, every time they're just about to say "ok, here's your script", my CD4 pops back up over 500. So they say "you're outside the guidelines". And I am, Mary, I am. There's no denying it.

There are no points in the guidelines that allow for length of time poz (such as "treat after seven years, regardless of numbers"). Maybe there should be. Maybe there will be as we learn more.

Another thing - my consultant is an hiv pharmacologist. He's one of the heads behind the hivinteractions.org website I often point people to. He knows his stuff when it comes to the meds (as well as the virus itself) and I do trust him. He's been in the field for nearly 30 years and has published scores of research papers concerning the meds. I know that if he thought I was in any real danger, I'd be on treatment pronto.

~gack~ I sound like I'm talking myself out of it, don't I. And that's what happens when I go to the clinic. I go in determined to demand treatment, but end up getting reasoned out of it again. Hopefully I'll be able to stick to my guns next week. The woman I'll be seeing just might write me that script, particularly when I tell her what happened to me in December. (I was sick for weeks.) I have a feeling that out of the three doctors I trust the most, she's probably the one who would relent the fastest. I requested her for a reason. See, there is method to my madness - sometimes.

You ask "don't you have any say in your health" - and yes, I do. I have plenty of say. But when treatment isn't recommended, it isn't recommended. Under the American system I can have pretty much anything I want - if I can pay for it. But that doesn't necessarily mean what I want is what I need. For example, in the Am I forum we see people paying for unnecessary PCR tests all the time. They wouldn't get that in the UK on the NHS unless there was a real need, and rightly so.

I know I could go totally postal on their asses next week and get that coveted script. BUT. That would get me labelled as a difficult patient and I don't need that particular mill-stone around my neck. I'll just have to keep working on countering their reasoned arguments with reasoned arguments of my own and hope they finally see it my way.

Hell, for all I know maybe my numbers have finally taken a proper dive since last July and this blahblahblah is all academic anyway because they'll call me back in two weeks saying "get your ass over here on the next flight!" ~shrugh~

I have no idea why my numbers do what they do. I don't think anyone really knows. Years ago I used to exhaust google looking for the answer, but I never found anything that was satisfactory. I gave up looking after a while and decided - "it just is, ok?"

Strictly speaking, my numbers aren't "up and down and up and down and all over the place" - they're stable. Aside from the odd time, my numbers don't really vary all that much. It takes a while to wrap your head around the fact that a VL of 10,000 (for example) isn't really all that different to a VL of 40,000. It's to do with a mathematical thingy called logs, but don't bother asking me about mathematical thingies. I'm clueless. (Matt aka Newt can explain it better than I) And fluctuations of as much as 100, give or take, in CD4s is completely normal during the course of a single day.

Don't be worrying too much about side-effects. You may not have any and chances are very good that you won't. I will be staying away from Sustiva because of my history of not playing well with meds that are known for possible psychological side-effects. Even then there's a chance I'd be ok, but it's a chance I've elected not to take. (see, that's one of the ways I do have control - they will not force any one combo down my throat. I can choose.)

Unless you have a history of bad reactions to meds or have a history of serious depression or other mental health issues, you'll more likely than not do just fine. Side-effects is one area that you DO NOT want to over-think. Your mind is a powerful thing and you can actually produce symptoms with the power of your own mind. So go easy, yeah?

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Has anyone else experienced this? How did you overcome it? I appreciate the feedback and really want to thank everyone that posts on here because it has totally helped me over the months learning about side affects, etc. etc. This is a great site!

Don't be apprehensive and try not to stress out about it. I'm on the same meds for about 5 years now. I take them once a day at night. I don't feel any side effects. I don't worry about any toxicity issues, that for the doctor to let me know from my blood tests, to me taking meds is like taking a vitamin.

If one doesn't work, you can always take another. I've probably taken 12 different ones and only got an allergic reaction to one. I don't listen exactly to what they tell me, sometimes I take it with food, sometimes I don't, I don't think it matters specifically with what I'm on. Sometimes I go out and have 2 or 3 drinks and take my meds when I get home. Sometimes I don't take them at midnight (my normal time) because I come home late. I try never to miss taking them, but maybe once a year I will forget to take them, or forget if I've taken them, but I came up with a system and put a 7 day supply of all the meds in a bottle and every Tuesday night I know to refill it. I don't buy the story that you become resistant to a medication if you stop taking it. On paper the tests have told me that I am, but I will take something that they say I am resistant to and it will work for me.

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Pray God you can copeI know you have a little life in you yet. I know you have a lot of strength left.

I don't buy the story that you become resistant to a medication if you stop taking it. On paper the tests have told me that I am, but I will take something that they say I am resistant to and it will work for me.

It's not a "story" and too bad you don't believe it. It's well known that if you stop certain HAART drugs the wrong way, resistance is a possibility and has affected real people.

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“From each, according to his ability; to each, according to his need” 1875 K Marx

It's not a "story" and too bad you don't believe it. It's well known that if you stop certain HAART drugs the wrong way, resistance is a possibility and has affected real people.

Possible yes, certain no. Has affected some, yes, has not affected others, yes again. I think people create their own anti placebo effect when they are told something won't work for them, and sometimes a medication that is said not to work on you will work in combination with others.

« Last Edit: February 15, 2012, 05:26:58 PM by LiveWithIt »

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Pray God you can copeI know you have a little life in you yet. I know you have a lot of strength left.

This is a tangent and I don't see how it relates to the OP's concerns. However, I was noting that you are providing misinformation.

Stop sustiva incorrectly risks resistance. For example. The risk is a fact. Nothing to do with your mumble jumble.

Not everyone who stops incorrectly develops resistance. Some do. No psychological mumbo jumbo. The virus has no mumbo jumbo. The virus mutates while there is non suppression but still Sustiva in the system.

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“From each, according to his ability; to each, according to his need” 1875 K Marx

I don't listen exactly to what they tell me, sometimes I take it with food, sometimes I don't, I don't think it matters specifically with what I'm on.

medications can be recommended "take with food" because studies have shown that food (a certain amount of calories and/or fat - refer to the package insert for the exact specifications) can assist (or sometimes hinder) in the absorption of the medication. Not eating with a medication that "requires" food means that your body will not absorb the proper amount intended for that dosage. In a worse case scenario, depedning on the medication's metabolic requirements and a person's strain of HIV, this could lead to resistance.

sometimes a medication that is said not to work on you will work in combination with others.

if you're supposedly seeing some medication work for you that a test has proven you have developed resistance to, then you are simply seeing the outcome of the work of the other drugs. "Correlation does not imply causation"

On paper the tests have told me that I am, but I will take something that they say I am resistant to and it will work for me.

I guess it depends on what you mean about "on paper" and "the tests". genotype and phenotype tests literally test your blood (and the HIV in it) against the meds and if any resistance is noted then those meds simply do NOT work for you. That's just how science works.

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leatherman (aka mIkIE)

All the stars are flashing high above the seaand the party is on fire around you and meWe're gonna burn this disco down before the morning comes- Pet Shop Boys chart from 1992-2015Isentress/Prezcobix

"I can totally understand and relate to your ambivalence, concerns, fears regarding starting meds. So you’re definitely not alone! My two main (highly emotional) concerns were (kinda still are): 1. Once I start there is no going back and 2. Why put pills in my body when it seems to be doing its job ok for the time being?"

I think you summed me up good here. That's certainly how I feel. I decided to set a date of April 6th to start, however, I am going to set up an appointment within the next couple of weeks to check my levels again and then make a final determination on April 6th. The thing that has played in my mind a lot is the "once I start, there is no going back."

In regards to LiveWithIt and Mecch conversation about resistance... my doctor definitely says there is proof for the virus being resistant. And you can most definitely develop it. So, while I don't want to argue, I believe there is a lot of science that backs up resistance and plus, I'd like to error on the side that will most benefit me and that is to take the meds as prescribed, on time, and not miss a dose. I simply don't want to play around with my life on that topic.

@Ann - wow, you must have fast fingers!! I do too actually. I can just type away from the top of my head and bam, before I know it, I have written a ton.

It is sad how people go bankrupt over health issues here. I worry about that now. I mean, anyone should really - as you never know. I am definitely a supporter of socialized healthcare, it just for some reason, seems to be so negatively looked upon here and i don't get it. We have other things that are socialized and I believe (don't quote me on this) is that all developed countries in the world have socialized healthcare to some degree except the US. I know this isn't about socialized healthcare so will stop there. I just wanted to comment

It sounds like you have some great care and some great resources! That is awesome. I have to ask though... so, you have to fly every time you go to a doctor appt? I can't imagine that, but it's just all what we get used to huh? At least during the one next week you can go with your hubby and make a day of it!

I do worry a bit about the mental part of it. I do have a history of depression and anxiety so will need to watch that very carefully. I'll ask my friends to be a bit on alert for the start and to remain cognizant of my mental state for awhile. Actually, I only have 2 friends that know, parents, and a mentor that I really talk to about this so will be limited. I am assuming that if I am really down, that I'll recognize it and that it won't be any different on meds than when I am not on them and get really down. I think that is a reason why my doc said he 'cautiously nods his head to Complera" - he's looking at the big picture and many things about me - not just the depression but if I were to ask him, he'd probably say that is a concern, but all the other positives outweigh.

And Hi Leatherman. I have seen you on a lot of other threads and often have helpful things to say!

I have to ask though... so, you have to fly every time you go to a doctor appt?

I can walk to my GP's office in less than three minutes from my front door. He takes care of anything not directly related to hiv and sometimes liaises with my hiv doc to make sure he prescribes the best med(s) for my needs.

But yes, my hiv doc is in Liverpool. I live in the Isle of Man (aka The Rock). It's an island in the middle of the Irish Sea, so I can fly, swim, or take the ferry. Swimming and the ferry take too long, so flying it is.

I could go to a clinic here on the Rock, but they do not have a dedicated hiv or ID doctor resident on the island. They fly an hiv doc over from Manchester about once a month, but I do not trust him with my hiv care and he is not very well respected in British hiv circles.

The Isle of Man is famous for the TT (Tourist Trophy) Motorcycle Road Races, Mark Cavendish, and tailess cats. And me.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

While this statement is backed by solid clinical studies, it may have to be revisited one day.

Statistical studies may hide some effects that only apply to a smaller section of the population.

See for example, people who got the Delta 32 mutation from both parents have a solid protection against the virus. people who got the Delta 32 mutation from one parent only a a good chance to have a 'mild' protection. Those people are not many and their specifics are lost in statistical analysis...

Some doctors are considering that it would be worthwhile to know if a time limited , scheduled, treatment would allow those people to restore the immune system well enough and run another 5-10 years without meds and so on...

The study that backs up this 'science' was not stratified by delta32 genotyping (as far as can remember). Which is why, someone who has significant CD4's in blood account and significant $ in bank account should be allowed to know (or learn) about their delta32 genostatus before making decision in hurry.

Unfortunately not current practice where I live, is, I , think, not 'forbidden' but not 'commercially' available. In other words practically not feasible...

Now that have done my research about thing, there are a number of things that I would have wanted tested before going on meds !

The only 'risk' factor that I had (which Ann did not have when she started her history) is ... age.And that test is free...

Mark my words. In 100 years they will learn that the best way to cope with and cure this disease is to take at least one medication which tests show you have developed a resistance to. I am Hivstradamus.

just kiddin.

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Pray God you can copeI know you have a little life in you yet. I know you have a lot of strength left.

to take at least one medication which tests show you have developed a resistance to.

once again, the science is that if your HIV has become resistant to a certain med, then that med is no better than a placebo (perhaps worse as it could be like a placebo with negative side effects) because that med will do absolutely nothing to keep your HIV from replicating.

unless you can provide some sort of study or report that repudiates the science behind phenotype testing, then you need to realize that what you're saying about the effectiveness of a drug, that you have been proven to have resistance to, is just hogwash and makes you sound silly.

and if you mean that you were just kidding, then I need to say that I don't find spreading false medical information funny at all. people come to this site looking for real scientific answers so that they can have the best health care and best health possible. Joking about taking meds that would be ineffective, and perhaps being exposed to nausea and other side effects, isn't much of a joking matter.

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leatherman (aka mIkIE)

All the stars are flashing high above the seaand the party is on fire around you and meWe're gonna burn this disco down before the morning comes- Pet Shop Boys chart from 1992-2015Isentress/Prezcobix

and if you mean that you were just kidding, then I need to say that I don't find spreading false medical information funny at all. people come to this site looking for real scientific answers so that they can have the best health care and best health possible. Joking about taking meds that would be ineffective, and perhaps being exposed to nausea and other side effects, isn't much of a joking matter.

I don't particularly think it's funny either when someone posts incorrect information about something as serious as hiv drug resistance - and then claims to be "just kidding". All it does is confuse people who are still struggling to learn about and understand all the important and nuanced information we need to know in order to live well with this virus. Why make it harder for people?

If you want to joke about stuff, there's a whole forum for that - Off Topic. Got it? Good. BTW, I'm not "just kidding".

And please do not hijack this thread further. I really don't care to read more excuses or protestation or to be told to "lighten up". The Treatment forum is a serious forum.

Thank you for your cooperation.

That aidsetc.org website looks to be a really good one, so thanks for that link Mike. It's a site I hadn't come across before.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

take at least one medication which tests show you have developed a resistance to.

Truly, this section tends to be serious about meds and understanding them.

While Some of the answers here do reflect current , sound, proven knowledge, sometimes things get over simplified and do not show that some doors are opening in treatment simplification and better, easier to take treatments.

One way to help the OP cope with the mental stress of starting meds is to put some light on the fact that treatment decisions, and treatments themselves, in 2020 will not be the same as they are in 2012, which are way different of what things where in 2000, etc.

I am not saying it NOT a lifetime committment. I am saying it is considered a lifetime commitment by 2012 standards

Now while the joke by LiveWithIt may not be of the taste of everyone, there is indeed some insight in it. There is a report (which I kind find the reference for, if needed, am sure read that, but I think this is not the topic here), that show that there is some benefit for some people with very complex resistance profile in adding EVEN some of the meds they are 'resistant' to to their regimen. Explaining why, seems to be something that the authors are still working on. One should be carefull when throwing 'science' at people's face

So back to the OP, one way of helping with the mental stress of starting meds, is to understand that, of the many strategies that are currently being explored to eradicate the virus, one will at some point be successfull. Hopefully, these strategies will ultimately be of help to every Hiver. Yet, not every one will benefit at first. People who are enrolling for current, early, eradication trials (such as myself) are required to be UD for an extended period of time, and, in some cases, they will only select those who are VL < 1. Which is something that is observed on a good number of people who have been UD for, say, 3 three years at least.

One way of handling the anxiety is to make the OP realize that treatment is a journey andit is a journey which route is uncharted but also includes a possible sterilizing or partial cure. Starting meds in 2012 is not the same as starting meds in 2000. Starting meds in 2000 was risky business, very much less so in 2012; Starting meds in 2012 is also preparing oneself to what will be available in 2020.

Now while the joke by LiveWithIt may not be of the taste of everyone, there is indeed some insight in it. There is a report (which I kind find the reference for, if needed, am sure read that, but I think this is not the topic here), that show that there is some benefit for some people with very complex resistance profile in adding EVEN some of the meds they are 'resistant' to to their regimen. Explaining why, seems to be something that the authors are still working on. One should be carefull when throwing 'science' at people's face

So back to the OP,

and speaking of the OP, your "reference" seeming to supporting LWI's opinion/joke of taking a med that the patient has resistance to really has nothing to do with our treatment-naive OP. The science for the OP is to have a genotype test done and not take any med to which their version of HIV would have resistance to; but to go with another one of the many regimens out there.

now that all depends on your point of view. First off, starting meds any year is better than dying of AIDS. and then starting meds in 2000 wasn't anything like risky business as by then HAART had been in effect for about 5 years, and HAART was thousands of times less risky than starting meds in 1990 when there was just AZT monotherapy. Now in 2012 starting meds is even easier and it will/should be even easier still come 2020.

Starting meds in 2012 is also preparing oneself to what will be available in 2020.

Really no one knows what the future will hold, so today we can only make our health plans based on what is available in the here and now. Actually starting meds in 2012 (if your health warrants it) has nothing to do with preparing for 2020; but simply staying healthy - and alive - until 2020.

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leatherman (aka mIkIE)

All the stars are flashing high above the seaand the party is on fire around you and meWe're gonna burn this disco down before the morning comes- Pet Shop Boys chart from 1992-2015Isentress/Prezcobix

@Ann - oh wow... Just looked it up on Google Maps... that must be pretty cool living there? Now... it totally makes sense why you fly!!! Looks like you're closer to Belfast than Liverpool... haha. I've been to Ireland twice but haven't been to England.

Thanks Leatherman for the link on genotype/phenotype. I bookmarked that one.

I'm not sure how to address some of the others... I think the 'old timers' have addressed things well. I am all about humor, don't get me wrong... but I would agree about not joking around about something like this. I don't want to offend anyone or piss anyone off... I was just looking for honest input from folks about starting meds when I posted this. And the response have been helpful.

I wonder if there is anyone else out there that is in my shoes... as in, hasn't started meds yet and going through the same?

I have made up my mind that I am going to get new tests done in the next week or so to see where I am at. The last time I got them done (Dec 6th), I had been traveling for 41 hours prior so I was tired, hadn't slept much, came from the the other side of the world, etc. and I would venture to guess that had a play in why things dropped so much. So, I'd like to see where I am at now again and see if I am back up above 500 - although, with that said, I should be looking at the percents, not the numbers...

I actually really liked Eric48's response below too. I think it helps to add perspective. The reality is, it seems like most people go through different treatments on this 'journey' and that while I may start on Complera, who knows what I will end up on. I may be on it for several years, or I may not be. And you are right Eric - it really is mental stress! That is actually something my doc has mentioned to me every time I have seen him. He worries or gets concerned about the amount of stress this is causing me (or has caused me) and that is actually one of the reasons (of many) he feels why it would be beneficial for me to start. A big stress has been lifted and that is determining which regimen to go with and that was Complera. Now, it's just the starting part.

I would agree, too, that it will be a journey. Not one by choice. But it really is kind of scary not knowing your course per se. It is unknown and I think that is why it's difficult to start. But then again, on the other hand, I'll never know until I do start. There is an HIV book I got when I first found out (forgot the name - very popular) but he talked about all of these things and how after starting, etc. that the HIV goes from the forefront to more of a nuisance in the background. It's just in the forefront for me now but some day, it will be more in the background. All of this... the thinking, the talking about it on here, and reading other people's responses, how they have dealt with it, others experiences... it's all just part of the processing of it all. I really am thankful for the folks on here!! I am a thinker and it helps to process through it all by reading others thoughts, etc.

I do have a question though... what does OP stand for? Oh... does it stand for "Original Post?"

After all this discussion, I am certainly wondering about my numbers now... will see. I have to ask... because it does run around in the back of my head... but anyone know anything about the Quad pill? Is there any articles on it as in where it is at in development, any estimation on when it will be out, how people are doing on it in clinical trials, how it compares to Atripla & Complera, etc. Just curious.

I hope no one feels offended if I don't answer specifically everyone's post. Forums like this are totally new for me so I don't know what the standard protocol is... or what the proper thing to do is in regards to responses. Trust me though... I have certainly read everyones - more than once

I wonder if there is anyone else out there that is in my shoes... as in, hasn't started meds yet and going through the same?

Forrest,

Like I stated before, I’m pretty much like you in this respect. And there are quite a few of us with the same dilemma! I go back and forth about beginning therapy too- sometimes within the same day or week.

But here are some cogent reasons to wait at this point:

1. You really can afford to wait at this point. There is no urgency. I firmly believe that it’s important to get mentally prepared before commencing a lifetime of therapy (as it is presently)- and we HAVE THAT CHOICE right now. Many others (and lots on this forum) weren’t as lucky. And why do I think it’s important to mentally come to grips with popping these pills? - Because if one is not mentally prepared you could end up with poor adherence which could lead to resistance. (I know some members don’t agree with me on this but this is what I think anyway).

2. Guidelines, the world over, DO NOT recommend starting therapy with CD4 counts > 500. I think it is optional in the US- but that is based more from a Public Health Policy Perspective (because an undetectable VL also reduces transmission by as much as 96%) than individual health perspective.

3. The START clinical trial study results that are to conclusively determine if there is a ‘net-benefit’ in starting meds with CD4> 500 have not been released. In the absence of this scientific 'evidence', any suggestion that starting meds at this stage will benefit you in the long-run is based not on evidence, but on ‘expert opinion’ (There is a clear difference).

That said, it really is your health and your body and you should do what you’re comfortable with (under the guidance of your doctor of course).

@Ann - oh wow... Just looked it up on Google Maps... that must be pretty cool living there? Now... it totally makes sense why you fly!!! Looks like you're closer to Belfast than Liverpool... haha. I've been to Ireland twice but haven't been to England.

I'm not sure if Belfast is closer or not, but there are far fewer flights and the ferry takes even longer as all ferry traffic originates out of Douglas (the capitol), on the east coast. I don't know of any medical patients who travel to Belfast for their care, but lots go to Liverpool or Manchester. (There were 58 "patient transfer" passengers the day our flight was delayed and only two of us were hiv patients.) Hiv isn't the only speciality that we don't have resident specialists for - it's because of the small population size. The common saying is... "seventy-thousand alcoholics clinging to a rock in the middle of the Irish Sea".

I have made up my mind that I am going to get new tests done in the next week or so to see where I am at. The last time I got them done (Dec 6th), I had been traveling for 41 hours prior so I was tired, hadn't slept much, came from the the other side of the world, etc. and I would venture to guess that had a play in why things dropped so much. So, I'd like to see where I am at now again and see if I am back up above 500 - although, with that said, I should be looking at the percents, not the numbers...

Yes, all that travel and lack of sleep could very well have had a transient effect on your numbers. Lots of things can and that's one of the reasons you should never get too excited - good or bad - by one single set of lab results. If you look at my number history, you'll see one result that was taken while I was still recovering from a stress-induced (work related) bout of shingles. The CD4 was low, but it rebounded by the next time I had labs done.

The numbers are important too, but the percentage tends to be more stable.

but anyone know anything about the Quad pill? Is there any articles on it as in where it is at in development, any estimation on when it will be out, how people are doing on it in clinical trials, how it compares to Atripla & Complera, etc. Just curious.

Have you explored the other sections of this website? There's a grey bar across the top of any forum page with tabs (some containing drop-down lists) with names such as Home, About, Treatment, Prevention, etc. In them you will find links to the Lessons and Drugs pages, amongst others. Take some time and check them out.

There is also a News section. There is a search box at the top of this page so you can find older articles that no longer appear on the main page. Anytime there are changes to any of the drugs (such as being approved for use or if they're still in trials) it will be reflected almost immediately in the Drugs pages. You can also sign up for newsletters - two are published, one from AIDSmeds.com and one from POZ.com.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

has a nice section on 'patients readiness' . They really put is as first thing to assess (unless patient is in critical condition...I suppose)

Back the the meds choice. Your not yet there, but there are 2 strategies:

- go for the 'safest' first, if you need a switch, then plan B is the one you consider that you ***may*** be at risk (although no risk factors have been identified) (stress increase)OR- go for the 'easiest', the one you think might be not the safest choice, the good news is that on Atripla, 80% of patients are doing fine and happy with it, so, you would not have to worry about food . Then your plan B is to go with Complera which you seem to think is safest for you. then there is no stress increase if you need to switch, on the other hand, you'll feel relieved...

Or 2 dishes: which one you are having first, the one you like most , or you keep that one for dessert. Me I start with the things I like less (veggies...); If I am full, then I can keep the delicacies for another time;

How to lower the anxiety. Let me get back to this one again (that is THE OP).

First in order to lower YOUR anxiety, you apparently decided to share (disclose) to your loved ones. Fine... That works for you... But what about them ? What about their anxiety ? don't you think it would help with your anxiety if thinking about the relief it will be for your loved ones ?

Not everyone has a choice about meds and disclosure. I happen to have the luxury of choice, and so do you (apparently). On top of that you even have he choice of timing !

You were asking about other people experience. Everyone is different.

In the middle of a slope you decide to go the easy way (walk down) or the more difficult one (walk up). I personally, went for :A - non disclosureB - a combo that is considered at the same time risky at initiation but very nice if you pass the initial period without problem (people who failed on it loathe that combo, since the initial SE are ... hum... well... tough..., but those who've passed love it !)

But on long run, I get the benefits of it: privacy, preserved self esteem, once daily, no food obligation, no cholesterol worries, etc...

There was an interesting language used in the previous US guidelines (not in the newest) about meds choice. among the many options A, B, C, D. there was one comment about A and B (but not about C and D and others). It said A saves the option of using B in case A fails, B saves the option of using A in case B fails;

In other words, in making decisions in a situation that (understandably) raises anxiety, it is a good thing to reflect on: what is my plan B ?

If you go with complera and (for some reason) need a change then your plan B is dreaded Atripla.On the other hand if you go Atripla first (which has a high record of success, BTW), then your plan B is complera.

Knowing that your plan B is 'softer' that your plan A may be one way of dealing with meds initiation anxiety.

Of course this is one patient (me...) way of coping with the anxiety of starting meds. May be not yours, may be not of others, but, at least, personal opinion and experience about this matter is what you were originally asking for.

Eric & Ann - I apologize. I never said thank you for your thoughtful replies. Appreciate it! I hadn't checked out some of those other areas so I will need to. There is a LOT on this site. I have looked through some other threads as well.

Eric - I think I feel most comfortable with Complera. I do like that you provided a different thought process and did a nice job at thinking outside the box so I appreciate that.

I actually gave blood today and made appt for March 6th (first available) but I am hoping I can get my main numbers prior to that (don't see why that would be an issue). So, will see what these numbers & percents are and then determine on whether or not to start on April 6th. I think that is my gameplan.

Something I haven't noted that is weighing into all of this is the need to change jobs and if I change jobs, I will be moving to a different state so all of that plays a role into starting. If my numbers are okay, I may just wait until I get moved (but that could be this summer/fall) so may or may not be able to wait. It all really comes down to the numbers. I know my doctor wants me to start and has wanted me to start since August. However, if my numbers come back above 500 and VL still low, then as someone has stated, it doesn't seem to make sense to start if over 500 CD4. Will see. I'll keep posted and let you know when I get the results back.

Something I haven't noted that is weighing into all of this is the need to change jobs and if I change jobs, I will be moving to a different state so all of that plays a role into starting.

a few words of caution about a move.

While most drug manufacturer websites have co-pay assistance and patient assistance programs to help cover the cost of either co-pays of the cost of the medicine itself, some people earn only enough and are eligible for their state's ADAP to help purchase medications or cover insurance premiums. If you fit in that category of being eligible for ADAP, make sure to NOT move into a state with an ADAP waiting list!! If you move into an area with a waiting list for ADAP and you need or you are eligible for ADAP, then you'll be screwed. For more information about states with ADAP wisting lists and state eligiblity requirements (certain meds or certain levels of meeting FPL (federal poverty level) visit http://nastad.org

Also make sure to move into an area with a clinic or doctor that can treat HIV. Do your research first or you may find yourself having to drive 100s of miles to get proper HIV care. Although this usually isn't a problem if you move into a larger city, traveling to get appropriate care is almost always an issue when moving to a more rural area. That's not to say though that rural area are ruled out. Some areas will surprise you and have wonderful health care facilities.

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leatherman (aka mIkIE)

All the stars are flashing high above the seaand the party is on fire around you and meWe're gonna burn this disco down before the morning comes- Pet Shop Boys chart from 1992-2015Isentress/Prezcobix

So, I have a thought going around in my head today... I have felt this before... but it plays into this decision. So, once again tonight, I am exhausted. It's typical. Over the past year, it seems like outside of work, I am just wiped. I will admit that my job is pretty stressful (more than I let myself think). However, I've been in the same role for 5 years. I am just wiped... and I can't help to think... my body is working it's ass off to keep my viral load as low as it is. It's working really hard. And like my doc said, when a person with untreated hiv goes to sleep, their body just continues to fight and fight during the night where a hiv negative person sleeps and their body repairs itself. Now, an hiv+ person's does repair over night but it's also fighting another battle (HIV) that is just non stop.

By going on medicine, it helps your body out so it's not having to do that battle. So, on a day like today, I feel like even if my numbers come back and let's say they are 500VL... that I think I would feel better if I were on meds because my body wouldn't be fighting so hard.

See where I am coming from? These are valid thoughts aren't they? I really do lack energy most of the time that is for sure. And, I have other rather large things going on my life at the same time, which doesn't help matters either. I am anxious to see my latest numbers though, nonetheless.